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Montana rates for HCPCS L5645

Addition to lower extremity, below knee (BK), flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$901.76 / $3,127.72 / $3,127.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,246.96 / $1,246.96 / $1,246.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.09 / $1,340.72 / $1,340.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.09 / $1,090.29 / $1,340.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533.91 / $1,276.88 / $1,340.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.09 / $1,006.27 / $1,341.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.81 / $477.77 / $757.74